Why obesity makes it hard to detect and treat heart disease

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A new review paper from Mayo Clinic published in the Journal of the American College of Cardiology discusses how obesity affects common tests used for diagnosing heart disease and impacts treatments.

Cardiovascular disease, the leading cause of death in the U.S. and globally, is largely preventable, with obesity being a key risk factor.

“Excess fat acts as a kind of filter and can skew test readings to under-or overdiagnosis,” says senior author Francisco Lopez-Jimenez, M.D., director of preventive cardiology at Mayo Clinic.

“Obesity affects nearly all the diagnostic tests used in cardiology, such as ECG, CT scan, MRI and echocardiogram.”

Treatment Challenges

Obesity also affects therapeutic interventions such as stent placement or heart surgery, making these procedures more difficult and increasing the risk of complications such as infection.

Common drug therapies to treat cardiovascular disease may need dosage adjustments in patients with obesity.

Some medications, like beta-blockers, can impede weight loss, leading Dr. Lopez-Jimenez to stress the importance of alternative approaches to prevent weight gain or facilitate weight loss.

Despite the challenges that heart patients may face, such as difficulty moving or experiencing symptoms like shortness of breath during exercise, Dr. Lopez-Jimenez emphasizes the importance of physical activity for both weight loss and heart health.

Comprehensive Approach

A standard weight loss program generally involves a therapist, dietitian, and sometimes a psychologist.

When these measures are not sufficient, other resources such as bariatric surgery and medications can effectively aid weight loss.

Mayo Clinic recently launched a multidisciplinary cardiometabolic program to address obesity, reduce related disease conditions, and enhance patients’ quality of life.

Accurately defining a person’s level of obesity is crucial. While body mass index (BMI) has traditionally been used to assess obesity severity, it does not account for muscle mass.

Hence, measurements such as waist-to-hip ratio and waist circumference offer a more accurate reflection of cardiovascular risk.

“In general, patients with heart disease and a particularly advanced degree of obesity will benefit from trying lifestyle modification.

And if that doesn’t work, or if they have tried that in the past, it is reasonable to consider bariatric surgery or medications,” says Dr. Lopez-Jimenez.

If you care about heart health, please read studies about the best time to take vitamins to prevent heart disease and calcium supplements could harm your heart health.

For more information about heart health, please see recent studies about when an aspirin a day to prevent heart attacks is too risky, and results showing daytime naps could help prevent heart attacks and strokes.

The study was published in the Journal of the American College of Cardiology.

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